Earlier this month, we reported on the unexplained withdrawal of a case report from the American Journal of Medicine whose authors said they had treated a man in St. Louis who used krokodil, a homemade mixture of prescription painkillers heroin and flammable contaminants that has proven deadly in Russia.
At the time, all the journal’s publisher, Elsevier, would say about why the article was removed was that there was “a permission problem that the originating institution is working to resolve.”
The paper has now reappeared. And contrary to the notice that appeared on the withdrawal — “A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated” — the article says nothing about why it was removed.
Forensic Tox Guy, who was highly critical of the earlier version, wrote this morning that the new paper is “much cleaner and coherent” but that “not much has changed between the two versions.” He concludes:
At the end of the day, I do agree that physicians (and other people) need to be aware of this drug. This article will make people aware, but I still await some real scientific evidence that krokodil is in the USA. Until we see evidence, it is illogical to be here and I remain a skeptic.
Hat tip: Nadia Awad via David Juurlik
Krokodil does not contain heroin.
Fixed, thanks.
The key quote is in Toxic Guy’s original critique:
” The usage of this sensationalism is merely perpetuating the media hysteria around this drug.”
From what I can tell (and this takes a total of 30 seconds on the google) there is no “flesh-rotting” drug. It is merely a poorly purified homemade preparation. If you inject gasoline, hydrochloric acid, or any of the other chemicals they say are used to make ‘krokodil’ you will probably get the same effect. It doesn’t matter what drug you think you are making or trying to make.
Some commentators say that cases of massive tissue damage from injecting unpurified drugs are, while not common, not unexpected.
As an aside, Leon Gussow has pointed out that krokodil is more a method for making a drug than it is an actual drug itself. Obtaining solid evidence that it is in the US would thus require testing for multiple toxicants that probably are not standard in most clinical labs (e.g. gasoline). It would be rather difficult. I think a case report of a patient with a solid patient-reported history and all the right symptoms is good enough to start with.